NHS: Staffing Levels

Tracy Brabin Excerpts

Tuesday 11th December 2018 Westminster Hall

[Tracy Brabin (Batley and Spen) (Lab/Co-op)]

I beg to move,

That this House has considered staffing levels in the NHS.

It is an honour to serve under your chairmanship, Mr Hollobone. It is a pleasure to lead this debate and I thank hon. Members for being present. I know that many are eager to contribute, and the fact that they have taken the time to be here, during one of Parliament’s more eventful weeks, emphasises the strength of feeling in the House about staffing levels in the NHS. I also thank the many organisations that have contacted me, offered support and shared their research.

It is clear that the issue of staffing in the NHS is a great and growing concern to many. Indeed, the case of my local NHS trust inspired me to apply for this debate. Most of my constituents rely on the Mid Yorkshire Hospitals NHS Trust for a range of acute hospital-based and community services. The trust serves not just the people of Batley and Spen, but more than half a million people across Wakefield and North Kirklees.

[Paula Sherriff (Dewsbury) (Lab)]

I thank my hon. Friend and neighbour for securing this important debate. My constituents also use the Mid Yorkshire Hospitals NHS Trust. There are still several hundred nursing vacancies there, and that is having a significant impact on the delivery of patient care. Does she agree that the chaos of the current Brexit situation is not helping to recruit nurses, potentially from the European Union?

[Tracy Brabin]

I shall go on to discuss that in more detail, but my hon. Friend and neighbour is absolutely right. We have both been in meetings with the trust where that has proved to be of great concern to it.

[John Howell (Henley) (Con)]

On a similar subject, is the hon. Lady aware that Oxford University Hospitals agreed today to fund the cost of obtaining settled status for EU nationals who work there?

[Tracy Brabin]

That is something that we have discussed with our trust. The cost should not necessarily fall on the shoulders of the people we want to employ, so that seems like a good thing.

[Gloria De Piero (Ashfield) (Lab)]

For Sherwood Forest Hospitals trust, which covers King’s Mill Hospital in my constituency, the latest figures show 200 nursing vacancies and, since nursing bursaries were abolished, a 32% decline in those applying to do it. Is it not time to bring nursing bursaries back?

[Tracy Brabin]

I absolutely agree that training for this most lauded position should not be done at the cost of nurses themselves.

[Jim Shannon (Strangford) (DUP)]

Does the hon. Lady agree that we must have fewer medical quangos and more medical professionals in their white doctors’ coats seeing patients; less cleaning up of paper trails and more cleaning up in wards and A&Es; and funding that is targeted at frontline staffing and reasonable rates of pay?

[Tracy Brabin]

Certainly, funding and support should be given to frontline staffing. I will go on to talk about how I see that playing out.

The Mid Yorkshire trust is a major employer of about 8,000 members of staff who operate across three hospital sites: Pinderfields Hospital, Pontefract Hospital and Dewsbury and District Hospital, which is in my constituency. Like many trusts across the country, the trust is feeling the pressure on recruitment. In the most up-to-date figures, which were given to me directly by the trust this week, there is a 10% vacancy rate. That includes 95 full-time-equivalent posts for medical staff, 209 vacancies for full-time registered nurses, and vacancies for all other posts covered by the trust. The trust tells me that its key workforce challenge remains recruiting registered nurses and junior doctors in training. Those staff shortages lead to expensive cover being required— a bill that is ultimately paid by the taxpayer.

I am pleased that the trust has taken steps to mitigate against staffing shortages, including an extensive recruitment programme where vacancies across the trust are advertised and marketed widely. It has introduced a new associate nurse role in partnership with a local university, and expanded and increased the number of apprenticeship opportunities to offer different routes into careers in the NHS. It has held open theatre days to promote particularly difficult roles to recruit for, such as operating department practitioners. Finally, it has increased the number of nurses and doctors on the local temporary staff bank, which reduces its reliance on, and the cost of, commercial agency staff. I am sure that all hon. Members agree that that is all great.

Despite that work, problems remain. I must put on record my concern that staffing shortages can lead to problems for patients. The ambulatory emergency care unit at Dewsbury and District Hospital opened in 2015 to care for patients who needed a quick diagnosis and treatment, and who could be treated without the need for admission to a hospital bed. Since July, it has been closed because of staff shortages and it will remain closed for the foreseeable future. It had also been closed from the end of December last year to early March. Patients now face the lengthy and expensive trip to Pinderfields Hospital.

In the most recent inspection at Mid Yorks, the results of which were announced last week, the safety of services was deemed to require improvement, which will cause deep concern to my constituents. We are now told that the harsh funding climate for our NHS, which has existed since 2010, is coming to an end—austerity is over.

[Stephanie Peacock (Barnsley East) (Lab)]

As the daughter of a nurse, I congratulate my hon. Friend on securing this important debate. I know she is a proud member of the GMB, like me, so I declare an interest in highlighting its survey, which showed that 78% of NHS and ambulance workers are incredibly concerned about staffing levels. Does she agree with a nurse from Barnsley who said that we need more registered nurses and trained support staff, not untrained volunteers, who are sometimes being used?

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[Tracy Brabin]

My sister is also a nurse. When someone has a nurse in the family, they understand how hard they work. My hon. Friend must be psychic, because I am about to go on to that point.

When it comes to the recruitment and retention of NHS staff, it could not be further from the truth that austerity is over. The Royal College of Nursing did not mince its words when it said:

“The UK is experiencing a nursing workforce crisis”,

particularly in England. With one in three nurses due to retire within a decade, we are looking at a perfect storm of increasing vacancies across health and care.

[Paula Sherriff]

Does my hon. Friend share my concern that, as a direct result of staffing shortages at Dewsbury and District Hospital, the midwife-led birthing unit has had to be closed several times? September was a particularly bad month for closures. That has a traumatic effect on mums-to-be, who expect to give birth there but turn up and get sent elsewhere.

[Tracy Brabin]

Capacity, particularly in midwifery, is a massive issue, and midwife recruitment is also a problem. A mum who is about to have a baby wants to make sure that they are guaranteed a bed and a midwife who will be with them throughout the process, so of course that is a concern. There are almost 41,000 vacant nursing posts in the NHS and it is estimated that that number will grow to almost 48,000 by 2023—just five short years away.

[Tim Farron (Westmorland and Lonsdale) (LD)]

The hon. Lady is being generous. Does she agree that the problem with the recruitment and retention of staff also stretches to our mental health services? In Cumbria, three years ago, the Government promised a specialist one-to-one eating disorder service for young people, which has yet to be delivered. Does she agree that it is not good enough for the Government to make promises that they cannot deliver because they cannot recruit the staff?

[Tracy Brabin]

We are seeing increasing problems around recruitment and retention in mental health services, which I will go on to. We know that nurses are heroes of our health service and that they will always voice their concerns.

A survey conducted by the RCN in 2017 had some deeply worrying results. More than half of the nurses said that care was compromised on the last shift and more than 40% said that no action was taken when they raised concerns about staffing. If there was any doubt about the commitment of nurses, nine in 10 were not paid for extra unplanned time worked in the NHS. Unpaid time worked by nurses in the NHS saves the NHS hundreds of millions of pounds a year.

I am not just talking about nurses and the worryingly low levels of recruitment. The Royal College of Physicians informs me that in Yorkshire and Humber 36% of physician consultant posts advertised were not filled. Across the UK, a total of 45% of advertised consultant posts went unfilled, due to the lack of suitable applicants. The RCP believes that we need to double the medical school places to 15,000 a year to alleviate this problem in the long term and it is seriously hard to disagree with that assessment.

The RCP is also calling for investment in public health initiatives, which I am sure is another thing that we all agree on. The desperate need for more mental health staff is well reported. The consultant psychiatrist vacancy rate in the northern and Yorkshire region, which Batley and Spen falls under, is 11.7%, which is higher than the average consultant psychiatry vacancy rate in England. One in 10 consultant psychiatrist posts are vacant. Doctors specialising in mental health are uniquely placed to look at a person’s brain, body and psyche. Such specialists will only become more important, so I ask the Minister to update Members on his plans to meet the target of 570 junior doctors specialising in psychiatry by 2020-21 and to say what plans he has to ensure that all trainee doctors have experience of working in psychiatric settings?

The British Medical Association has provided information on the potential impact of Brexit on staffing levels in the NHS. Nearly 10% of doctors working in the UK are from the European economic area. Doctors, as well as many other professionals, make a massive contribution to our NHS. However, the BMA warns that many EEA doctors continue to feel unwelcome and uncertain about their future here. Given the uncertainty that we have seen in the past few days, I imagine that that feeling will not change any time soon. The results could be devastating, with more than a third of doctors from the EU considering moving away from our country. That is the last thing we need, as hospitals are already chronically understaffed, with more than one in four respondents to a BMA survey reporting that rota gaps are so serious and frequent that they cause significant problems for patient safety.

Alarmingly, some doctors feel bullied into taking on extra work. It is clear that something needs to change, particularly now we are in winter again. There are too few staff, who are too stretched, and trusts across the country are struggling to fill vacancies. However, in order to fix a problem, we need to know whose remit it is to provide a solution. Shockingly, there are no specific legal duties or responsibilities at UK Government level to ensure that health and social care providers have enough staff to provide safe and effective care to meet the needs of the population. Health Education England has some powers related to the higher education supply. In practice, however, those powers relate only to the funding for the 50% of their courses that nursing students spend on placements. Health Education England no longer commissions higher education university places, meaning that it is responsive to students signing up for nursing courses rather than proactively seeking them based on areas of need and workforce planning.

We know that the number of European workers in the NHS has fallen dramatically since the referendum. Mid Yorks recruited highly skilled workers from the Philippines, but delays to visa applications meant that 50% of them have now gone elsewhere and into other jobs. We need to do better than that.

The case is clear to me and to many others that we need a proactive and accountable power-holding body that makes robust assessments of population need, and uses that need to calculate the workforce requirements. No action has been taken to assess the level of population need for health and social care support now or in the future. Nobody has calculated how many nurses are needed to meet those needs safely and effectively. No workforce strategy is in place to set up the mechanism through which new registered nurses can be generated through a supply line.

Workforce plans are not consistently available and when they are they are based on affordability and finance, rather than on the expertise and skills mix of staff required to care for patients. Plans are limited in their ability to make effective change. Providers may identify a need for more nursing posts but then find themselves unable to fill them. Vacant posts stay vacant and gaps on the frontline are filled by more expensive bank and agency staff, and—as we heard from my hon. Friend the Member for Barnsley East (Stephanie Peacock)—by volunteers, or substituted lower-qualified staff. Patient care is left undone, with lengthening waiting lists.

That is the sad truth of where we are and when the Minister responds I would be grateful to know what plans are in place to enforce accountability for the NHS workforce. Simon Stevens has confirmed that the long-term plan for the NHS could not definitely deal with the NHS workforce and there are serious concerns that without investment a new plan will ultimately fail.

Six years on from the Health and Social Care Act 2012, it is still unclear which organisation is accountable for workforce strategy. Too often, no one is taking responsibility. Health Education England has been consulted, but it has failed to deliver a workforce strategy. Now is the time for leadership and action, and I look forward to hearing from the Minister.

[Several hon. Members rose—]

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[Tracy Brabin]

I thank colleagues from both sides of the House for their contributions, particularly those with frontline experience, and I thank the Minister for his measured response.

I have a couple of points. First, I am sure the Minister can feel the sense of urgency in this debate. Although I appreciate that long-term discussions are needed, we still do not have a date for when the long-term plan will be published or for the consultation on the Royal College of Nursing proposals. The Minister said it would be soon, but when will we have that?

[Stephen Hammond]

There is a commitment from the Government to produce the long-term plan before the end of the year, as the hon. Lady knows, and I have written to Dame Donna to request a meeting to discuss the RCN’s proposals.

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[Tracy Brabin]

That is very reassuring.

We hear from across the House that mental health is receiving such little support. People are hanging by a thread. Nurses are saying to their organisations and their MPs, “I am worried for the health and safety of my patients. I’m doing too many shifts. I’m absolutely shattered. I can’t guarantee that I am going to be doing my job properly. They’re bringing in volunteers to support me on the ward.” It is an absolute crisis. While I understand that the wheels of government work very slowly, I hope that the Minister takes from this debate that Brexit has been a universal issue. We are losing staff members. I welcome the commitment to an extra 5,000 doctors and so on, but that is just plugging the gap of the staff who are draining away from our hospitals and frontline services.

[Stephen Hammond]

I absolutely recognise that Brexit is a pressure on the system, but we should also recognise that there are 4,367 more professionals working in the NHS from the EU than there were at the date of the referendum. It is important to put that on the record.

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[Mr Philip Hollobone (in the Chair)]

Order. I call Tracy Brabin.

[Tracy Brabin]

If that is the case, the statistics are welcome, but in my constituency we are losing European members of staff. We cannot get away from the overall numbers—there are staffing shortages of 10%. In my constituency and in my trust they cannot recruit, because of various issues. I am grateful that the Government listened when I raised the question of tier 2 visas with the Prime Minister, when we wanted to bring over a paediatrician but could not because the visa took so long that he got another job. I welcome that when it comes to nurses, too, but we have to accept that there are things such as the bursary—